Acta Neurochirurgica (2025) 167:179
Microsurgical fenestration of pineal cysts significantly improved symptoms in 94% of non-hydrocephalic patients with nonspecific symptoms, with no mortality or severe adverse events. Cyst size and radiological features did not predict outcomes. The study supports fenestration as a safe, effective treatment, but optimal indications remain unclear.
• Microsurgical fenestration of pineal cysts (PC) was studied as a treatment for symptomatic patients without hydrocephalus.
• Most patients had nonspecific symptoms like headache, dizziness, and sleep disturbances; nearly all saw surgery as a last resort.
• 47 patients were analyzed, with an average follow-up of about 7 years post-surgery.
• Significant symptom improvement was observed: mean pain score (VAS) dropped from 7 to 1, with 96% reporting relief.
• No mortality or severe complications occurred; minor complications included CSF leaks (10%) and one surgical site infection.
• No clinical or radiological factors predicted better outcomes; even small cysts could benefit from surgery.
• Fenestration of both anterior and posterior cyst walls was seen as key to success, potentially safer than full resection.
• Further research is needed to define indications, optimal technique, and pathophysiology of symptomatic pineal cysts.
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